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The difference between health insurance and medical aid

Health insurance, medical insurance and medical aid. Is there any difference? The short answer is yes. While health insurance and medical insurance are synonyms used to describe the same product, medical aid is a more comprehensive form of insurance that falls under a different governing body and has its own set of costs, benefits, rules and regulations that are associated with it.

When deciding on the best option to suit your healthcare needs, it’s important to understand the core differences and benefits between these services:

1. Medical aid

Medical aid is a type of insurance whereby the member will pay a monthly fee or premium to cover medical-related requirements. This can include hospital care, doctors’ visits, medication and more. Both the day-to-day and in-hospital needs covered under medical aid are more comprehensive than those offered through health insurance, and this service is therefore more expensive.

Key features:

  • Medical Aid is governed by The Council for Medical Schemes and the South African Medical Schemes Act.
  • Treatment cover is based on a specific medical scheme tariff.
  • Payments are typically made directly to the healthcare provider.
  • Fixed monthly fees.
  • Prescribed Minimum Benefits (PMBs).
  • Does not offer additional benefits such as death or funeral cover.
  •  May not cover all specialists or certain treatments.
  •  Sometimes has a financial shortfall, in which case the patient will be required to cover the price difference out-of-pocket or through additional “gap cover”.

2. Medical or health Insurance

Medical or health insurance is an insurance aimed to cover medical-related expenses, and also offers day-to-day benefits as well as additional policy options.

Key features:

  • Governed by the Financial Services Board.
  • Often more affordable than medical aid, but offers less coverage.
  • Covers treatment at fixed amounts. These payments are generally made to the member who will then decide how best allocate the funds.
  • Covers only certain types of illnesses, injuries or procedures.
  • Is subject to waiting periods.
  • Members will generally pay one set fee or premium for their family.
  • Often will allow you to add additional benefits such as accident and emergency cover, hospital cash and maternity lump sum benefits, and death or funeral cover.

At Bloom, we offer a variety of health insurance options to suit your needs and budget. Contact us today, and a member of our expert Bloom team will call you back to answer any questions.